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Organization
BACK TO BASICS DENTAL CENTER, LLC
Active
Organization
BACK TO BASICS DENTAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER CORNELL DDS (OWNER)
(931) 645-8000
Entity
Organization
Contact information
Practice address
1762 HIGHWAY 48, STE A, CLARKSVILLE, TN 37040-7284
(931) 645-8000
Mailing address
1762 HIGHWAY 48, STE A, CLARKSVILLE, TN 37040-7284
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8416
TN
Other
Enumeration date
01/19/2012
Last updated
09/16/2015
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